非手術方法治療脊椎硬膜外膿瘍：一病例報告

Non-surgical Treatment of Spinal Epidural Abscesses: Report of One Case

林捷忠(Chieh-Chung Lin) ； 遲景上(Ching-Shiang Chi) ； 陳永忠(Young-Chung Chen) ； 李永磐(Young-Parn Lii)

《Acta Paediatrica Sinica》 32卷5期 (1991/10) Pp. 325-329

摘要

脊椎硬膜外膿瘍在小兒科爲罕見疾病。本病例爲一兩歲男童，因有腦膜刺激現象，經初步脊髓穿刺檢查並送細菌培養後，臆斷爲細菌性腦膜炎，給予抗生素治療。因高燒不退及意識變化，三天後再做脊髓穿刺檢查，流出膿狀流體。由於懷疑病童有脊椎硬膜外膿瘍，故做脊椎核磁共振攝影檢查，證實爲非常廣泛之脊椎硬膜外膿瘍（第二頸椎至腰薦椎）。病童之血液及脊椎培養均長金黃色葡萄球茵，經改用抗生素後，病情迅速進步。因爲侵犯的範圍多達二十三節脊椎，爲了避免手術引流造成脊柱側彎的後遺症，故不採用成年病人常用的手術引流療法，只由靜脈給予抗生素治療。病童於住院六個星期後痊瘉出院，並繼續口服抗生素三個月。

並列摘要

Spinal epidural abscesses (SEA) are uncommon in children, This paper reported a two-year-old boy who was noted to have neck stiffness, with local tenderness posteriorly. Bacterial meningitis was suspected initially in terms of the finding of the cerebral spinal fluid; antibiotics were prescribed. Three days later another spinal tap was performed because of persistent high fever and irritability. A pus-like material drained out as the needle punctured into the spinal region. A magnetic resonance image (MRI) scan of the spine revealed a SEA, with extensive involvement from the second cervical spine to the lumbosacral spine region. Culture of the pus, as well as the blood and CSF, were positive for Staphyllococcus aureus, Because of extensive involvement of the spinal epidural space, the patient was again given antibiotics: Prostaphllin and Amikin intravenously for six weeks instead of laminectomy. Then the oral antiboitic (Keflex) was given to the patient for another three months after the boy was discharged from the hospital.
A review of the literature shows the incidence of SEA to be increasing and the bacterial spectra to be broadening because of increasing use of immunosuppressing drugs or antibiotics, and the increase in numbers of immunecompromised patient. The clinical symptoms and signs of the SEA were nonspecific, but SEA can be early diagnosed by computurized tomography (CT scan or MRI scan with caution. The literature suggests that, if the patient's condition fits the criteria for non-surgical treatment, antibiotic therapy is the first choice for preventing the complication of spinal deformity, especially in children.

並列關鍵字

spinal epidural abscesses ； children ； non-surgical treatment ； extensive